Osteo Integrated Implant in Maxillofacial Rehabilitaiton Hed23993

Osseointegrated Implant Based Dental Rehabilitation in Head and Neck
Reconstruction Patients
Sydney Chng, MD, PhD1,2,3, Roman J. Skoracki, MD1, Jesse C. Selber,

MD1, Peirong Yu, MD1, Jack W. Martin, DDS, MS4, Theresa M. Hofstede,
DDS4, Mark S. Chambers, DMD, MS4, Jun Liu, MD, PhD1, Matthew M.
Hanasono, MD1
Department of Plastic Surgery, The University of Texas MD Anderson

Cancer Center, Houston, Texas, USA
2
Department of Plastic Surgery, Royal Prince Alfred Hospital, Sydney, New

South Wales, Australia
3
The Institute of Academic Surgery, University of Sydney, New South Wales,

Australia
4
Dental Oncology Section, Department of Head and Neck Surgery, The

University of Texas MD Anderson Cancer Center, Houston, Texas, USA
Running Title: Osseointegrated Implants
Funding: No funding was received for this study.
Presented at: American Association of Plastic Surgeons 2013 Annual
Meeting, New Orleans, LA
Key Words: Head and Neck Cancer; Osseointegrated Implants;
Microvascular Free Flaps; Fibula Free Flap; Prosthodontics
CORRESPONDING AUTHOR
Matthew M. Hanasono, M.D.
Department of Plastic Surgery
University of Texas M. D. Anderson Cancer Center
1515 Holcombe Boulevard, Unit 443
Houston, Texas 77030
Telephone: 713-794-1247
Fax: 713-794-5492
Email: mhanasono@mdanderson.org
This article has been accepted for publication and undergone full peer review but has not been
through the copyediting, typesetting, pagination and proofreading process which may lead to
differences between this version and the Version of Record. Please cite this article as an
Accepted Article, doi: 10.1002/hed.23993
This article is protected by copyright. All rights reserved.
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Abstract
Background: Dental restoration is an integral part of head and neck cancer
reconstruction.
Methods: We evaluated the success rate of osseointegrated implants in head
and neck cancer patients, comparing outcomes between implants placed in
fibula free flaps to those placed in native mandibular and maxillary bone.
Results: A total of 1132 implants were placed in 246 patients. The overall
implant loss rate was 3.7% and was higher in fibula flaps (8.2%) compared to
the native mandible (2.6%) and maxilla (2.2%), although these differences did
not reach statistical significance (p=0.059 and p=0.053, respectively). The
failure rate was 8.0% for implants placed after radiation and 3.6% in patients
who did not undergo radiation (p=0.097). Osteoradionecrosis occurred in 19
patients (7.7%) following implant placement, and tobacco use was found to be
a risk factor (p=0.027).
Conclusions: Osseointegrated implants are reliable in head and neck cancer
patients including those undergoing bony free flap reconstruction.
John Wiley & Sons, Inc.

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Introduction
Advances in reconstructive surgery, particularly in the area of
microvascular reconstruction, have resulted in improved aesthetic and
functional outcomes for patients with head and neck cancer. However, in spite
of increasingly sophisticated reconstructive techniques, head and neck cancer
patients frequently lack functional dentition, which not only affects mastication,
but speech, swallowing, and appearance as well. Dental rehabilitation with
conventional prostheses following radiation therapy, tumor resection, and/or
flap reconstruction is often unsuccessful due to altered tissue contours and
lack of adequate dentition for fixation. In many cases, stable prosthetic
retention can only be achieved with the use of osseointegrated implants.1,2
The reliability and efficacy of osseointegrated implants have been well
documented in the non-cancer, edentulous population.3 In contrast, the
reliability, safety, and utility of osseointegrated implant placement in the head
and neck cancer population remains incompletely defined, mainly due to the
limited availability of large, single-center reports in the literature. Successful
dental restoration with implants is more challenging in this population given
the surgical resection of bone and mucosa and irradiation of oral cavity
tissues, as well as a high prevalence of tobacco use and other risk factors for
impaired healing. Additionally, implants in this population are often placed
into osseous free flaps.4-6 While successful osseointegration into osseous free
flaps has been reported in several case series, it is unclear whether they are
as reliable as implants placed into native mandibular and maxillary bone.
Our primary objective was to determine implant success rates in head
and neck cancer patients, comparing the outcomes of osseointegrated

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implants in vascularized osseous free flaps to implants placed in native
mandibular and maxillary bone. A secondary objective was to assess the
effect of risk factors associated with poor healing, such as radiation therapy,
chemotherapy, tobacco use, and diabetes mellitus. Finally, we evaluated how
many patients completed dental restoration, including implant placement,
uncovering, abutment placement, and prosthesis delivery.
Methods
This is a retrospective review of head and neck cancer patients who
underwent osseointegrated implant placement at our institution between 2005
and 2011, during which data was prospectively collected on patients who
received osseointegrated implants for dental restoration. Institutional review
board approval was obtained prior to undertaking this study. Dental
oncologists trained in prosthodontics placed all implants.
In our practice, patients with satisfactory remaining dentition and
dentoalveolar architecture are rehabilitated with conventional non-implantretained prostheses. In patients who were judged to require osseointegrated
implants for adequate prosthetic stability or had failed a trial of conventional
prosthesis use, implants were recommended provided the patient was
motivated to undergo the multi-stage procedure and would agree to regular
follow-up and practice adequate hygiene care. Insurance preauthorization
was sought in all potential osseointegrated implant candidates, and, as other
centers have experienced, only obtained in a subset of patients. Those
whose insurance would not reimburse for implant rehabilitation were given the
option of bearing the costs on their own.

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Implant success was defined as a painless and stable fixture without
evidence of peri-implant infection or radiographic lack of osseointegration.
The implant survival time was defined as the time interval from date of implant
placement to the date of implant failure or last follow-up date, whichever
occurred first. The Kaplan-Meier product-limit method was used to estimate
the cumulative survival rates. A log-rank test was used to compare the
cumulative time to first-implant-loss rate among the various groups.
A generalized estimating equation (GEE) model was applied in testing
for risk factors associated with implant loss, accounting for within-patient
correlation in the estimation. The chi-square and Fishers exact tests were
used as appropriate to investigate the association between various
parameters and successful completion of oral rehabilitation. Using step-wise
model selection, a multivariate logistic regression model was used to estimate
the odds ratios (OR) associated with significant risk factors for the
development of osteoradionecrosis. All tests were two-sided. A p-value of
<0.05 was considered statistically significant. The analyses were performed
with SAS 9.2 (SAS Institute Inc., Cary, NC).
Timing and Technique for Osseointegrated Implant Placement

Implants were placed in the native mandible, native maxilla, and/or
vascularized osseous free flap in two stages:
Stage 1. Patients who underwent surgery had immediate or delayed
osseointegrated dental implant placement relative to the time of
ablative/reconstructive surgery whereas non-surgical patients received
implants in their native mandible and/or maxilla (following prophylactic dental

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extraction if indicated) prior to commencement of radiation therapy. All
osseous free flaps receiving osseointegrated implants in this study were fibula
free flaps.
Astra Tech implants (Dentsply Implants, Mannheim, Germany) were
used in all patients. When present, titanium reconstruction plates and screws
were partially or entirely removed if they interfered with proper placement of
osseointegrated implants in the delayed setting. Free flap skin paddle
debulking was performed as needed to optimize the soft tissue contour over
the alveolar ridge or fibula for prosthetic fitting.
Stage 2. The implants were uncovered, tested for stability (manually,
rather than by resonance frequency analysis, which is an objective measure
of magnet-induced vibration, not available at out center), and fitted with
abutments. Any unstable implants were removed or not used. Final soft tissue
modifications, including further free flap skin paddle debulking and
vestibuloplasty, which involved deepening the gingivolabial or gingivobuccal
sulcus and full-thickness skin grafting held in place with a bolster for 5 days,
were performed when necessary to create an optimal soft tissue platform for
the dental prosthesis. After healing, a removable dental prosthesis was
fashioned to complete the restoration, and revised subsequently as
necessary. Completion of Stage 2, with prosthesis fabrication and functional
loading of the implants, was considered a surrogate marker for successful
completion of dental implant oral rehabilitation in this study.
Results

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A total of 1132 implants were placed in 246 head and neck cancer
patients, including 166 males and 80 females, with a median age of 59 years.
Other demographic information, including potential risk factors for implant loss
is shown in Table 1. The dose of radiation ranged from 60 to 72 Gray and
intensity modulated radiation therapy (IMRT) was the modality used. Due to
the retrospective nature of the study, the precise radiation fields could not be
obtained and, therefore, it was not possible to estimate dosimetry to each of
the implant sites. Active tobacco use was defined as cigarette smoking within
30 days of implant placement. The diagnosis of diabetes mellitus included
patients with non-insulin dependent diabetes mellitus requiring treatment with
oral hypoglycemics (rather than diet-controlled) or insulin-dependent diabetes
mellitus. Primary tumor types, sites, and T and N classifications are shown in
Table 2.
Osseointegrated implants were placed immediately (at the time of
surgical ablation) in 115 patients (46.7%), and delayed in 90 patients (36.6%).
An additional 41 study patients (16.7%) did not undergo resection or flap
reconstruction. This group was treated with definitive radiation therapy or
combined radiation and chemotherapy, and underwent implant placement
following dental extraction 4 to 6 weeks prior to starting radiation therapy.
Osseointegrated implants were placed prior to beginning radiation therapy in
147 patients (59.8%) and after the conclusion of radiation therapy in 18
(7.3%). Eighty-one patients (32.9%) did not receive any radiation.
Sixty-six patients (26.8%) received soft tissue free flap reconstruction,
including radial forearm free flap (n=32), anterolateral thigh free flap (n=27),
ulnar artery perforator flap (n=4), rectus abdominis myocutaneous free flap

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(n=2), and lateral arm free flap (n=1). Sixty-seven patients (27.2%) had
osseous reconstruction using a fibula free flap. Fifty-four patients (22%) had a
total of 243 osseointegrated implants placed in their fibula free flaps (mean
number of implants, 4.5; range, 2-9). One hundred eighty-five patients had a
total of 618 implants placed in the native mandible, and 90 patients had a total
of 271 implants placed in the native maxilla (Table 3). The rate of successful
implant osseointegration and retention in the mandible, maxilla and fibula free
flap were 97.4%, 97.8% and 91.8%, respectively. There was a trend for
reduced implant survival in fibula free flaps as compared with the native
mandible and maxilla that did not reach statistical significance (p=0.059 and
p=0.057, respectively).
Overall, 42 of the 1132 implants (3.7%) were lost in 22 of 246 patients
(8.9%) at a median time of 33.7 months (range, 0.9 to 92.7 months). Further
analysis revealed that the implant failure rate was progressive over time,
increasing from 1.4% at 12 months to 3.9% with follow-up greater than 36
months, and to 5.1% for those followed over 60 months (Table 4). Most of the
implants lost in the native mandible and maxilla occurred in the first 3 years,
but implants placed in fibula free flaps experienced increasing attrition beyond
60 months (Figure 1). In the group that received surgery with or without
chemoradiation, 37 implants out of 964 were lost (3.8% loss rate). In the
group that received only radiation or radiation plus chemotherapy, 5 out of
168 implants were lost (3.0% loss rate). This difference was not statistically
significant (p=0.82).
Implant failure was more common in the subgroup that had implants
placed after radiation therapy (8.0%), compared to those who did not undergo

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radiation therapy (3.6%). This difference, however, was not statistically
significant (p=0.097) (Table 5 and Figure 2). Further analysis based on the
site of implant placement showed that implants placed in a fibula that never
received radiation were less likely to fail than those placed in bone that had
received radiation prior to or following radiation (5.1% vs.13.0% and 18.6%,
p<0.001 and p<0.001, respectively) (Table 6). Furthermore, all implants that
were lost in patients who received radiation prior to implant placement were in
the fibula group (18.6%, 0%, and 0% for loss rates for implants placed in
fibular, mandibular, and maxillary bone, respectively). Note that 32 patients
undergoing fibula free flap reconstruction for mandibular and maxillary defects
did not receive radiation. Although radiation is typically indicated for high T
classification tumors, 8 of the 32 patients had recurrent cancer and had
already received radiation for their initial cancer, 8 had non-squamous cell
cancers for which it was deemed that adjuvant radiation was not indicated,
and 16 underwent reconstruction for osteoradionecrosis (ORN).
ORN following implant placement occurred in 19 patients (7.7%)
including 4 cases that involved implants placed into fibula free flap and 15
cases involving implants placed into native maxillary or mandibular bone. Of
the 4 cases of ORN occurring in patients who had a fibula free flap
reconstruction, all 4 resulted in loss of all implants, and, in 1 case, resulted in
a pathologic fracture that was treated with bony debridement and re-plating.
ORN in patients with mandibular implants was associated with pathologic
fracture and required segmental mandibulectomy and fibula free flap
reconstruction in 4 cases. Early stage ORN cases underwent sequestrectomy
for exposed bone and removal of dental implants if involved.

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A univariate analysis examining age>65, diabetes mellitus, active
smoking (vs. prior smoking and nonsmoking status), chemotherapy, and free
flap type (none vs. soft tissue free flap vs. fibula free flap), demonstrated
active smoking to be a significant risk factor for the development of ORN
(p=0.027; other data not shown). Similarly, a multivariate logistic regression
model for the development of ORN also found active smoking to be a
significant risk factor (OR=2.84; 95% confidence interval (CI)=1.01-7.98;
p=0.048).
Long-term follow-up information was incomplete for 16 patients (6.5%),
including 10 who pursued dental rehabilitation at another institution. Of the
remaining 230 patients (93.5%), 184 (80.0%) completed Stage 2 (i.e.,
fabrication of and functional loading with permanent prosthesis). The median
time from implant placement until completion of Stage 2 was 7.0 months
(range, 1.1 to 23.2 months).
Disease recurrence was associated with failure to complete Stage 2
(p<0.001; Table 7), and its predictive value was confirmed on multivariate
analysis (OR=0.22, 95% CI=0.10-0.46, p<0.001). The median time interval
between date of surgery and recurrence was 11.2 months (range, 1.1 to 36.3
months). Other reasons for not completing dental rehabilitation included a
combination of postoperative oral incompetence or trismus, financial
constraint, progression of co-morbid conditions that precluded further surgery,
heavy peri-implant soft tissue overgrowth, and patient choice.
Discussion

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Osseointegrated implants provide prosthetic retention that is generally
superior to traditional dentures secured by clasps to the remaining teeth or
dental adhesives in the edentulous. Osseointegrated implants also result in
retention of bone height, while traditional dentures are associated with gradual
bone loss. In edentulous patients, bone loss is frequently progressive over
time to the point that stable fixation is impossible. This is an outcome study of
osseointegrated implant dental rehabilitation in a large oncologic patient
cohort from a single institution. The results demonstrate that osseointegrated
implants are very reliable, even in a cohort of highly challenging patients.
Our overall implant survival rate of 96.3% at a median follow-up period
of 33.7 months (92.8% and 92.2% for those followed up to 3 and 5 years,
respectively) is within the range of figures previously reported in the literature,
which includes implant survival rates of 81 to 99%, averaging 87% in studies
ranging from 0 to 10 years in head and neck cancer patients.2,5-12 In keeping
with Shaw et al.2 and Watzinger et al.,13 but in contrast to Schliephake et al.,14
we found the vascularized free flaps to be less reliable in retaining
osseointegrated implants, though still with a relatively high survival rate of
91.8%.2,13,14
In this study, the administration of radiation therapy, and the sequence
of radiation therapy in relation to implant placement did not significantly affect
the implant survival rate, except in fibula free flaps. In our series, 59.8% of
patients who underwent surgical resection of a primary tumor either
underwent implant placement at the time of ablative surgery into the native
mandible or maxilla, or in cases of microvascular osseous free flap
reconstruction, as a secondary staged procedure into the neomandible that

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took place prior to commencement of radiation therapy while 7.3% of patients
had implant placement following the completion of radiation therapy. Primary
or early implant placement has been thought to be more reliable because the
detrimental effects of radiation therapy on bone do not seem to begin until
about 6 weeks after radiation therapy has started.15 Since radiation therapy
does not usually begin until 4 to 6 weeks following the ablative surgery, it is
believed that there is sufficient time for osseointegration to take place prior to
exposure to the damaging effects of radiation therapy.4
The proponents of secondary implant placement have argued that a
delayed approach allows for more comprehensive assessment of disease
status, oral function, and patient motivation, as well as more precise
prosthetic planning.4 Several clinical studies, supplemented by histology
studies in animals, have demonstrated that dental osseointegrated implants
placed in irradiated recipient bed are reliable.2,3,16-18 Most, however, advocate
for a delay of at least nine months following radiation therapy to allow for
recovery of the bony tissue from the deleterious effects of irradiation on
cellularity and vascularity.19,20 While our failure rates for implants placed into
irradiated native mandibular and maxillary bone was 0%, the 18.6% failure
rate for implants placed into fibular bone suggests that irradiation might be
considered a relative contraindication to implant placement in osseous free
flaps.
The incidence of ORN occurring after implant placement in our patient
cohort was 7.7%. A recent paper by Tsai et al.21 from our institution quoted a
7.5% ORN rate among 402 oropharyngeal cancer patients receiving definitive
radiation therapy between 2000 and 2008. Epstein et al.22 found the incidence

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of mandibular ORN in head and neck cancer patients to range from 5.8 to
44.2% based on approximately 4000 subjects in 13 studies combined. These
disparate figures may result from the subjectivity in diagnosis, with the
spectrum of presentation ranging from a clinically inconsequential small area
of bone exposure to a complex orocutaneous fistula or a pathologic fracture,
and the varying clinicodemographic parameters within different patient
population. In our series, several pathologic fractures were noted in implanted
patients and required segmental mandibulectomy and bony free flap
reconstruction. Our experience with implant loss secondary to ORN in fibula
free flaps is limited, but, in all 4 cases recorded, resulted in complete loss of
all implants placed into the free flap, and fibular fracture in 1 case.
Active smoking was a predictor for ORN in our patients. Other factors
reported in the literature to be associated with ORN include radiation therapy
to more than 50% volume of the mandibular body, alcohol consumption,
larger tumors, advanced age, increased radiation dose, hyperfractionation,
dentate (versus edentulous) state, post-radiation dental extractions, tumor
location (retromolar trigone at increased risks), poor oral hygiene and poor
nutritional status. Given the morbidity of ORN observed in our series, we
would recommend that active smoking in irradiated patients be considered a
contraindication to secondary implant placement in all patients, and that it
probably even be considered a contraindication to implant loading in patients
who have had implant placement prior to irradiation.
Some evidence suggests that hyperbaric oxygen (HBO) therapy is
associated with improved outcomes in preventing and healing late radiation
tissue injury in the head and neck.23 However, it has not been found, based

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on the limited amount of clinical research available, to offer any appreciable
clinical benefits specifically in irradiated patients requiring dental implants.24
Because HBO is employed as treatment rather than prophylaxis for ORN in
our practice, we are unable to answer the question of whether it is effective in
preventing implant loss with our data.
In this series the oral rehabilitation completion rate was 80%. Other
studies have quoted completion rates of 35 to 75%.7 While patient selection in
this series may be considered liberal, our practice is governed to a large
extent by practicality; many of our patients are referred from distant locations,
and desire to consolidate surgical procedures, favoring primary implant
placement. Patients are asked to opt for implant placement many times at the
start of their cancer treatment, in order to minimize the number of surgical
procedures as well as to avoid implant placement following radiation therapy.
However, at that time, the final oral function (i.e., speech and swallowing) is
unknown, as is the potential other functional problems, such as oral
incompetence or trismus that might result in patients not completing dental
rehabilitation. In this initial experience, we did try to select for patients who
had good oncologic and functional prognosis to undergo implant placement,
but acknowledge that functional outcomes in head and neck cancer are often
hard to predict and may change over time, resulting in failure to complete
dental restoration or a prosthesis that is primarily cosmetic in nature, which
may still be of considerable value to many patients. Because cancer
recurrence is the predominant obstacle to completion of oral rehabilitation, an
argument can be made for delaying implant placement, for example, until after
the median time to diagnosis of recurrence (11.2 months following definitive

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treatment), particularly in patients with more advanced disease. Of note, in
our practice, osseointegrated implant dental rehabilitation has been generally
funded by health insurance or, less commonly, self-funded.
Some have advocated the replacement of free flap skin paddle around
osseointegrated implant with mucosal grafts because the latter protect against
marginal bone loss and peri-implant inflammation.25 We routinely debulk the
fibula free flap soft tissue and skin paddle for implant placement, but have not
found peri-implant skin to be problematic enough to prompt a change in
practice. In non-irradiated patients in whom the soft tissue component is
bulky, the skin paddle can be excised in a delayed setting and the periosteum
left to mucosalize.
One challenge in studying implant loss is the most appropriate way to
count and analyze endpoints.13 Comparison of outcomes from previously
published papers on osseointegrated dental rehabilitation has to be
undertaken with caution. There is reasonable overall agreement on the criteria
for implant survival/success, but there continues to be a lack of consensus on
the most appropriate form of statistical analysis. Varied treatment protocols
and reconstructive techniques further compound making effective
comparisons. We decided to study our patients undergoing osseointegrated
implant placement utilizing a simple input/output analysis when presenting
implant survival/loss, Kaplan-Meier curves to depict time to first implant loss in
a patient, and a GEE model in testing for risk factors associated with implant
survival in order to account for within-patient correlation.
Conclusions

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Osseointegrated dental rehabilitation is safe and reliable in head and
neck cancer patients. Implant failure rates are higher in fibula free flaps
compared to the native mandible or maxilla, but success rates still exceed
91%. Radiation therapy adversely affects implant survival in fibula free flaps
but not the native mandible or maxilla. Disease recurrence is the biggest
impediment to successful completion of rehabilitation.
Based on our findings, we consider patients who have received or will
receive cancer treatment for curative intent, demonstrate motivation for dental
rehabilitation and compliance with proper oral hygiene, and have the financial
and social resources to complete the dental rehabilitation process candidates
for osseointegrated implant placement. If patients have received prior
irradiation, we require that they not be active smokers. We consider prior
irradiation a relative contraindication to implant placement in fibula free flap
bone. We are now actively exploring the effect of hyperbaric oxygen on
improving success rates in this subgroup.

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Figure Legend
Figure 1. Time to first osseointegrated implant loss by osseointegrated
implant site.
Figure 2. Time to first implant osseointegrated loss by timing of radiotherapy.

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Tables
Table 1. Patient characteristics
Variable
No. of Patients (%)

(n=246)
No. of Implants (%)

(n=1132)
Age >65 Years
88 (35.8)
383 (33.8)
Preoperative Radiation
18 (7.3)
100 (8.8)
Postoperative Radiation
147 (59.8)
695 (61.4)
Chemotherapy
99 (40.2)
480 (42.4)
Tobacco Use
102 (41.5)
471 (41.6)
Diabetes mellitus
38 (15.5)
153 (13.5)

Page 23 of 30
Head & Neck
23
Table 2. Primary tumor type, site, and classification.
Subsite
Type
Buccal
FOM
Lip
Mandible
Nasal/
Pharynx
Skin
Tongue
Maxillary
ACC
Adenocarcinoma
Ameloblastic
Desmoid Tumor
Fibrosarcoma
Hemangio-
Melanoma
MEC
ORN
22
Osteosarcoma
SCC
23
46
16
41
39
T1
T2
13
T3
13
10
T4
32
11
10
N0
13
23
10
N1
N2a
11
N2b
13
N2c
N3
Recurrent
Carcinoma
endothelioma
Abbreviations: ACC, adenoid cystic carcinoma; FOM, floor of mouth; MEC,

mucoepidermoid carcinoma; ORN, osteoradionecrosis; SCC, squamous cell
carcinoma.

Head & Neck
Page 24 of 30
24
Table 3. Osseointegrated implant loss by sites
Site
Median
Followup Time
(Yrs.)
Total No.
of
Patients
No. of
Patients
With Implant
Loss (%)
Total No.
of
Implants
No. of
Implant
Loss (%)
All
patients
2.8
246
22 (8.9)
1132
42 (3.7)
Mandible
2.8
185
9 (4.9)
618
16 (2.6)
Maxilla
2.6
90
3 (3.3)
271
6 (2.2)
Fibula
3.1
54
10 (18.5)
243
20 (8.2)*
*The implant loss rate in fibula flaps was not significantly lower than in the
native mandible (p=0.059) or native maxilla (p=0.057).

Page 25 of 30
Head & Neck
25
Table 4. Cumulative osseointegrated implant loss rate
Cumulative implant loss rate
Site
1 year
3 years
5 years
All patients
1.4%
3.9%
5.1%
Free flap
2.6%
7.4%
7.4%
Mandible
0.9%
3.3%
4.5%
Maxilla
1.3%
2.0%
4.7%

Head & Neck
Page 26 of 30
26
Table 5. Univariate analysis of risk factors for osseointegrated implant loss
Variable
No. of Successful
Implants (%)
No. of Implants
Lost (%)
p-Value
Age >65 years
363 (94.8)
20 (5.2)
0.322
92 (92)
8 (8)
0.097
673 (96.8)
22 (3.2)
0.734
Pre- or Postoperative
Radiation
765 (96.2)
30 (3.8)
0.704
Active Smoking
457 (97)
14 (3)
0.441
Diabetes Mellitus
147 (96.1)
6 (3.9)
0.832
Chemotherapy
471 (98.1)
9 (1.9)
0.162

Page 27 of 30
Head & Neck
27
Table 6. Osseointegrated implant loss by site and timing of radiotherapy
Site
Fibula
Mandible
Maxilla
Timing of
Radiation
Total no. of
implants
placed
Total no. of
implants lost p-Value
(%)
No Radiation
177
9 (5.1)
Preoperative
Radiation
43
8 (18.6)
Postoperative
Radiation
23
3 (13.0)
No Radiation
123
2 (1.6)
Preoperative
Radiation
38
Postoperative
Radiation
457
14 (3.1)
No Radiation
37
1 (2.7)
Preoperative
Radiation
19
Postoperative
Radiation
215
5 (2.3)

0.041
0.769
0.303
Head & Neck
Page 28 of 30
28
Table 7. Univariate analysis of parameters in completion of dental
rehabilitation*
Variable
No. of Patients Completing

Oral Rehabilitation
p-Value
Age >65 Years
69 (82.1%)
0.609
12 (66.7%)
0.357
110 (82.7%)
0.471
Pre- or Postoperative Radiation
122 (80.8%)
0.729
Chemotherapy
69 (75.8%)
0.239
Tobacco Use
73 (77.7%)
0.505
Diabetes Mellitus
27 (75%)
0.496
Recurrence
31 (60.8%)
<0.001
*Overall 80% of patients completed dental rehabilitation

Page 29 of 30
Head & Neck
253x253mm (300 x 300 DPI)

Head & Neck
253x253mm (300 x 300 DPI)

Page 30 of 30

Osteo Integrated Implant in Maxillofacial Rehabilitaiton Hed23993

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Osseointegrated Implant Based Dental Rehabilitation in Head and Neck

Sydney Chng, MD, PhD1,2,3, Roman J. Skoracki, MD1, Jesse C. Selber,

Department of Plastic Surgery, The University of Texas MD Anderson

Department of Plastic Surgery, Royal Prince Alfred Hospital, Sydney, New

The Institute of Academic Surgery, University of Sydney, New South Wales,

Dental Oncology Section, Department of Head and Neck Surgery, The

Head & Neck

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Timing and Technique for Osseointegrated Implant Placement

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No. of Patients (%)

No. of Implants (%)

Age >65 Years

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Abbreviations: ACC, adenoid cystic carcinoma; FOM, floor of mouth; MEC,

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Table 3. Osseointegrated implant loss by sites

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